Mid-urethral sling
Stress urinary incontinence (SUI), referring to ‘involuntary loss of urine on effort or physical exertion, or on sneezing or coughing‘, is the most common type of urinary incontinence, affecting over 10-20% of women.
When stress urinary incontinence affects quality of life and conservative measures fail, surgery may be of help.
Amongst the available surgical treatment options, mid-urethral sling (MUS) has been regarded as an effective and safe surgical treatment for SUI since its inception in the late 1990’s.
The procedure involves tension-free placement of a 1 cm wide polypropylene tape or sling between the vagina and the mid-point of the urethra.
There are three main routes for placing a MUS:
- retropubic
- transobturator
- single-incision or ‘mini-sling’
The selection of the surgical route is often determined by the experience of the treating surgeon and individual patient’s factors such as body-mass-index (BMI), previous surgery and the type of stress urinary incontinence.
Systematic reviews of numerous studies comparing MUS with traditional SUI surgical procedures have confirmed that MUS is highly effective in the short and medium term and has all the benefits of a minimally invasive procedure, with good safety profile, less blood loss, less operative time, fewer hospital stays, fewer haematomas and fewer wound infections.
MUS carries risks inherent in any surgical procedure for stress urinary incontinence as well as those risks associated with the use of permanent mesh. The former includes failure, voiding dysfunction, urinary retention, worsening or de-novo urgency, urinary tract infection, and pain related to vaginal scarring. The latter includes mesh exposure through the vagina and into the lower urinary tract.
In view of recent conflicting scientific-medico-legal publicity and negative media reports concerning surgical management of pelvic organ prolapse and urinary incontinence, it is important to note that the Australian Commission Quality and Safety in Health Care, the Royal Australian and New Zealand College of Obstetricians & Gynaecologists, and and international institutions such as the International Urogynecological Association (IUGA) have published positional statements supporting MUS as an effective and safe surgical procedure for women suffering from SUI.
The International Urogynecological Association (IUGA), a professional medical association dedicated to the global advancement of urogynecological knowledge and patient care through education and the promotion of basic and clinical research on disorders of the female pelvic floor, has also published a detailed Q&A document to provide answers to frequently asked questions about the use and the risks and benefits of the mid-urethral slings (or tapes) https://www.yourpelvicfloor.org/mesh-mid-urethral-slings/.
Finally, a detailed Patient Information pamphlet and Consent Booklet has been produced by NHS Scotland to help women fully understand the relevant issues when asked to provide informed consent for the Mid-urethral sling https://www.gov.scot/publications/synthetic-vaginal-mesh-mid-urethral-tape-procedure-surgical-treatment-stress-urinary-incontinence-women/.
RANZCOG Position statement on MUS-(C-Gyn-32)
ACSQH Patient-information-resource-transvaginal-TV-mesh-Stress-Urina…